Douglas A Thoroughman, Prevention Branch, CDC, Division of Viral Hepatitis, IHS National Epidemiology Program, 5300 Homestead Rd., N.E, Albuquerque, NM, USA, Amy V Groom, IHS National Epi Program, Indian Health Service/CDC, 5300 Homestead RD. NE, Albuquerque, NM, USA, Stephanie R. Bialek, Epidemiology Branch, CDC, Division of Viral Hepatitis, c/o Beth Bell, 1600 Clifton Rd., NE, Mailstop G-37, Atlanta, GA, USA, Diana Hu, Indian Health Service, Tuba City Indian Medical Center, P.O. Box 600, Tuba City, AZ, USA, Stephanie Adams, School of Medicine, MPH Program, University of New Mexico, Albuquerque, NM, USA, James E. Cheek, National Epidemiology Program, Indian Health Service, 5300 Homestead Rd., NE, Albuquerque, NM, USA, and Beth P Bell, NCID/VR, CDC, 1600 Clifton Rd, NE, MS G37, Atlanta, GA, USA.
KEYWORDS:
Hepatitis A; Hepatitis A Vaccination; American Indian/Alaska Native; Indian Health Service; Vaccination Coverage; Quality Assurance.
BACKGROUND:
Hepatitis A, historically endemic in American Indian/Alaska Native (AI/AN) communities, has decreased dramatically since hepatitis A vaccine became available in 1995. Questions remain about whether vaccination explains this decline.
OBJECTIVE(S):
To examine hepatitis A vaccination rates, on-time coverage, and missed opportunities in AI children in rural versus urban, and Indian Health Service (IHS) vs. non-IHS health care settings in the Southwest U.S.
METHOD(S):
A list of 3 - 6 year-old AI children was obtained for each facility. A random sample of children was chosen from each list and medical and computer records reviewed for hepatitis A, DTP, and MMR vaccination information.
RESULT(S):
Over 50% of children in IHS-operated facilities had received two doses of hepatitis A vaccine; nearly 80% had received at least one dose. Children receiving the fourth dose of DTP by 24 months were significantly more likely to complete the hepatitis A vaccination series (RR 1.1, 95% CI 1.1-1.2). Preliminary results for non-IHS facilities indicate that less than 30% of children had received two doses and less than 60% had received one dose. On-time coverage improved in successive age cohorts in both IHS and non-IHS facilities.
CONCLUSIONS(S):
Hepatitis A vaccination has been implemented in facilities surveyed and has improved over time but coverage levels may not be high enough to avert future hepatitis A epidemics. IHS facilities had fully vaccinated a higher proportion of children against hepatitis A than non-IHS facilities.
LEARNING OBJECTIVES:
Participants will be able to: discuss the relationship between hepatitis A vaccination and the decrease in hepatitis A disease in AI/AN populations; describe the current status of hepatitis A vaccination programs in the surveyed facilities.
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